1. Raising the priority of noncommunicable diseases in development work at global and national levels
Presentation for discussion
(Not an official document)

2. Causative risk factors
Four types of noncommunicable diseases are largely preventable by means of effective interventions that tackle shared modifiable risk factors
Causative risk factors
Tobacco use
Unhealthy diets
Physical inactivity
Harmful use of alcohol
Noncommunicable diseases
Heart disease and stroke 
Diabetes
Cancer
Chronic lung disease

3. Total number of deaths in the world (2004)
fact
60% of the world's annual deaths are due to noncommunicable diseases. Approximately 25% of these deaths are premature and could be prevented
10%
70 million
60 million
5.8 M
50 million
26.0 M (above the age of 60)
40 million
35 million (60% of all deaths)
Source:
30 million
9.0 M
(below the age of 60)
25% of 35 million
20 million
18.0 M
10 million
Total number of deaths in the world (2004)
Group III - Injuries
Low-income countries
Group II – Other deaths from noncommunicable diseases
Group II – Premature deaths from noncommunicable diseases (below the age of 60), which are preventable
Group I – Communicable diseases, maternal, perinatal and nutritional conditions

4. Estimated deaths from cardiovascular diseases (2004)
fact
More people die from heart diseases and strokes in the poorest developing countries than in the richest industrialized countries
8.2 m
2030
9.0 m
2.6 m
3.8 m
6.1 m
7.3 m
2015
2.6 m
3.4 m
Source:
Low income countries
5.1 m
Lower middle-income countries
6.5 m
2004
Upper middle-income countries
2.4 m
High income countries
3.0 m
2 million
4 million
6 million
8 million
10 million
Estimated deaths from cardiovascular diseases (2004)

5. The top-10 leading causes of death
In all developing countries, premature deaths from noncommunicable diseases account for a large enough share of the disease burden to merit a serious policy response
fact
The top-10 leading causes of death
Low-income countries
Middle-income countries
High-income countries
Lower respiratory infections (11.2%)
Coronary heart disease (9.4%)
Diarrhoeal diseases (6.9%)
HIV/AIDS (5.7%)
Stroke and other cerebrovascular diseases (5.6%)
Chronic obstructive pulmonary disease (3.6%)
Tuberculosis (3.5%)
Neonatal infections (3.4%)
Malaria (3.3%)
Premature and low birth weight (3.2%)
Stroke and other cerebrovascular disease (14.2%)
Coronary heart disease (13.9%)
Chronic obstructionary pulmonary disease (7.4%)
Lower respiratory infection (3.8%)
Trachea, bronchus, lung cancers (2.9%)
Road traffic accidents (2.8%)
Hypertensive heart disease (2.5%)
Stomach cancer (2.2%)
Tuberculosis (2.2%)
Diabetes mellitus (2.1%)
Coronary heart disease (16.3%)
Stroke and other cerebrovascular diseases (9.3%)
Trachea, bronchus, lung cancers (5.9%)
Chronic obstructive pulmonary disease (3.5%)
Alzheimer and other dementias (3.4%)
Colon and rectum cancers (3.3%)
Diabetes mellitus (2.8%)
Breast cancer (2.0%)
Stomach cancer (1.8%)
Source:

6. Attributable deaths in developing countries by risk factor
Unsafe water, sanitation, hygiene
Indoor smoke from solid fuels
Tobacco use
High blood glucose
Low fruit and vegetable intake
Overweight and obesity
Physical inactivity
Sub-optimal breastfeeding
High cholesterol
Urban outdoor air pollution
Underweight
Unsafe health care injections
Unsafe sex
Alcohol use
Unmet contraceptive need
Vitamin A deficiency
Occupational risks
Global climate change
High blood pressure
Child sexual abuse
Zinc deficiency
Lead exposure
Illicit drug use
Iron deficiency
fact
The risk of dying in developing countries from causes attributable to high-blood pressure, tobacco use, high blood glucose or physical inactivity
Attributable deaths in developing countries by risk factor
7 million
6 million
5 million
4 million
3 million
2 million
1 million

7. Without action, Africa will witness the largest increase in deaths from noncommunicable diseases in 2015 (vs 2004)
fact
2.5 million
30%
25%
2.0 million
20%
1.5 million
15%
1.0 million
10% 5% 0%
Africa
Americas
East.
Med
Europe
South-
East
Asia
Western
Pacific
Africa
Americas
East.
Med
Europe
South-
East
Asia
Western
Pacific

8. 10 leading causes of deaths in females (2004)
fact
Noncommunicable diseases are among the leading causes of death among women in developing countries, as well as high-income countries
10 leading causes of deaths in females (2004)
Source: WHO's report on "Women and Health: today's evidence, tomorrow's agenda"

9. Populations in low- and middle-income countries
At household level, noncommunicable diseases are affecting the poorest people in developing countries disproportionally
fact
Poverty at household level
Populations in low- and middle-income countries
Globalization
Urbanization
Population ageing
Increased exposure to common modifiable risk factors:
Unhealthy diets
Physical inactivity
Tobacco use
Harmful use of alcohol
Noncommunicable diseases:
Cardiovascular diseases
Cancers
Diabetes
Chronic respiratory diseases
Loss of household income
from unhealthy behaviours
Loss of household income
from poor physical status
Limited access to effective and equitable health-care services
which respond to the needs of people with noncommunicable diseases
Loss of household income
from high cost of health care
14 million people die prematurely each year
in developing countries from noncommunicable diseases
Poverty contributes to noncommunicable diseases and noncommunicable diseases contribute to poverty

10. fact
Noncommunicable diseases are the third largest global risk in terms of likelihood and the fourth largest global risk in terms of economic severity
Oil spikes
Retrenching from globalization
Asset price collapse
Food price volatility
Noncommunicable diseases
Financial crisis
"A problem neither the developed world nor the developing world can afford"
"Declining development assistance has already led to a significant reduction of public spending on health in many countries. When funds are limited, governments tend to focus on basic health services, in line with the MDGs, at the expense of the prevention and treatment of noncommunicable diseases."
(WEF Global Risk 2010 Report)
Infectious diseases
World Economic Forum: Global Risk 2010 Report

11. Total number of deaths in low- and middle-income countries (2004)
fact
In developing countries, more than 8 million premature deaths from noncommunicable diseases per year are omitted from the MDGs
60 million
50 million
5.3 M
20.0 M
8.1 M
17.4 M
40 million
14.2 M
30 million
Source:
20 million
10 million
Not covered by the MDGs:
More than 8 million premature deaths from noncommunicable diseases
0 million
Total number of deaths in low- and middle-income countries (2004)
Group III - Injuries
Low-income countries
Group II – Other deaths from noncommunicable diseases
Group II – Premature deaths from noncommunicable diseases (below the age of 60), which are preventable
Group I – Communicable diseases, maternal, perinatal and nutritional conditions

12. Health ODA Commitments (2007) in US$ billions
fact
International development agencies have been slow in responding to the call to raise the priority accorded to noncommunicable diseases in development work
Health ODA Commitments (2007) in US$ billions
HIV/AIDS & STDs
$7.40
Health Policy & Admin. Management
$1.65
Infectious Disease Control
$1.33
Reproductive Health
$1.16
Basic Health Care
$1.14
Total Health ODA: $22.1 billion
Health ODA for noncommunicable diseases: 503 million (~2%)
There is no OECD/DAC Creditor Reporting System code yet to track health commitments for the prevention and control of noncommunicable diseases
Malaria Control
$0.80
Family Planning
$0.53
Tuberculosis Control
$0.45
Basic Nutrition
$0.33
Medical Services
$0.24
Basic Health Infrastructure
$0.23
Medical Research
$0.22
Medical Education/Training
$0.21
Health Education
$0.06
Water Supply/Sanitation - Large Systems
$3.90
Water resources policy/admin. mgmt
$0.93
Basic Drinking Water Supply & Sanitation
$0.92
Waste Management/Disposal
$0.42
River Development
$0.10
Water Resources Protection
$0.06
Water Education/Training
$0.01
Source: Kaiser Family Foundation (
(Based on analysis of data obtained via online query of the OECD Development Assistance Committee (DAC) Database and Creditor Reporting System (CRS) on 31 May 2009)

14. fact
In May 2008, WHO Member States started to mobilize a global response to address noncommunicable diseases, with a particular focus on developing countries
2000
Global Strategy for the Prevention and Control of Noncommunicable Diseases
Global Strategy on Infant and Young Child Feeding
2002
WHO Framework Convention on Tobacco Control
2003
2004
Global Strategy on Diet, Physical Activity and Health
2008
Action Plan on the Global Strategy for the Prevention and Control of Noncommunicable Diseases

15. 2. Establishing and strengthening national policies and programmes
The Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases was endorsed by the World Health Assembly in May 2008
fact
Six objectives:
1. Raising the priority accorded to noncommunicable diseases in development work at global and national levels, and integrating prevention and control of non-communicable diseases into policies across all government departments
2. Establishing and strengthening national policies and programmes
3. Reducing and preventing risk factors
4. Prioritizing research on prevention and health care
5. Strengthening partnerships
6. Monitoring NCD trends and assessing progress made at country level
Under each of the six objectives, there are sets of actions for Member States, the WHO Secretariat and international partners

16. ECOSOC High-level Segment on Global Health (Geneva, 6-9 July 2009)
fact
Many public health leaders are calling on global development initiatives to take into account the prevention and control of noncommunicable diseases
Regional Ministerial Meeting on Health Literacy (Beijing, April 2009)
Regional Ministerial Meeting on Noncommunicable Diseases and Injuries, Poverty and Development (Qatar, May 2009)
ECOSOC High-level Segment on Global Health (Geneva, 6-9 July 2009)
ECOSOC Ministerial Roundtable Meeting on Non-communicable Diseases and Injuries (Geneva, 8 July 2009)
Doha Declaration on Noncommunicable Diseases
ECOSOC Ministerial Declaration
Continuing discussions at the UN General Assembly

17. High-level forums are starting to call for the inclusion of noncommunicable diseases into discussions on development
fact

18. Increase resource availability (both financial and human capital)
fact
At the occasion of the 2009 ECOSOC High-level Segment, WHO launched a new global network to combat noncommunicable diseases (NCDnet) on 8 July 2009
Mission of NCDnet:
Help implement the Action Plan by catalyzing a multi-sectoral, multi-level response, with a particular focus on developing countries
Goals of NCDnet:
Increase focus on prevention and control of noncommunicable diseases through collective advocacy
Increase resource availability (both financial and human capital)
Catalyze effective multi-stakeholder action with a focus on country-level implementation

19. International Advisory Council Global/Regional Forum Meetings
NCDnet is composed of the WHO Secretariat staff, an International Advisory Council, NCDnet Global and Regional Forum meetings and functional Working Groups
fact
WHO
International Advisory Council
Funding/Resourcing
Mechanisms
Global/Regional Forum Meetings
Working groups
Advocacy
and Communications
Innovative Resourcing Mechanisms
Monitoring and evaluation
Partnership capacity
building